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New faces in accreditation: Part 3

September 18, 2013
by Alison Knopf
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Part 3 of 4
Patricia Barrett

Read part 2

This month, Behavioral Healthcare talked to four behavioral health accrediting organizations, two of which — The Joint Commission and CARF — named new executive directors — Michael Johnson and Tracy Griffin Collander — to head their behavioral health accreditation programs just this year.  They, together with Brett Welch of ACHC and Patricia Barrett of NCQA, shared their views about health reform and its impact on accreditation-related products and offerings.

NCQA

On July 30, the National Committee for Quality Assurance (NCQA) released the latest version of its Managed Behavioral Healthcare Organization (MBHO) accreditation. This is a direct response to healthcare reform, which requires that all health plans offered on the exchanges must be accredited. If the plans offer behavioral health services through an MBHO, contracting with accredited organizations will be helpful to them.

Patricia Barrett, NCQA’s vice president for product development, said the new accreditation was created with two tasks in mind: supporting managed behavioral healthcare accreditation, and laying out behavioral health requirements for those entities that are not carving out behavioral healthcare, but offering it with their larger healthcare plans.  

In addition, NCQA has done separate work on patient-centered medical homes and practices to integrate behavioral and physical health issues, says Barrett. “There’s an expectation for coordination and continuity,” she says.

Because states are contracting with managed behavioral healthcare organizations to provide Medicaid services, they are driving a higher-needs population into the managed care marketplace, says Barrett. The Affordable Care Act requires plans offered through the exchanges not only to be accredited, but also to measure their performance, which is a cornerstone of NCQA health plans, she says. “So yes, the marketplace is definitely feeling the pinch as it relates to the varying reporting and compliance obligations they have,” says Barrett. But in terms of patient protections, accreditation is key.

The MBHO accreditation will look at screening programs – ensuring that patients are screened adequately and then properly treated for behavioral health problems. It will also look at the methods of information exchange between behavioral health and other providers, says Barrett. Finally, it will look at basic protection of patient rights, “making sure they understand what their benefits are, and that they understand their appeal rights,” says Barrett.

The process works by the MBHO first submitting documentation to NCQA, which validates it off and on site. “We review files about denials and appeals, we review complaints, we look at member protections,” says Barrett.

Part 4 Coming soon!

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